Web-hosted Engine for Continuously Improving the Identification of Safer Products for Administration

ABSTRACT

Genetic information relating to clinically significant attributes are generated as unique molecular signatures, which are provided to a subscriber to be carried as a card or in another form, including for display by a subscriber&#39;s computer or smart-phone or PDA. The signature is periodically updated as new clinically significant attributes become known. The process of updating the signature and using it to obtain suitable products (which don&#39;t have an unacceptable risk of generating an adverse reaction or outcome) is also described.

RELATED APPLICATIONS

This application claims the benefit of Provisional Application No.61/990,906, filed May 9, 2014.

BACKGROUND

In the United States today, transfusion of incompatible blood is asignificant factor contributing to morbidity and mortality especiallyfor individuals whose clinical condition or disease—such as sickle celldisease, thalassemia and hematologic malignancies including leukemia andmyelodysplastic syndrome—requires periodic transfusion of one ormultiple types of blood cells. At present, a minimal degree ofcompatibility between donor and recipient “blood types” is ascertainedin accordance with a “type & screen” paradigm by determining the majorphenotypes, defined in terms of the antigens AB (which define the ABOblood groups) and RhD, and screening recipients for alloantibodiesagainst other antigens, and only if such antibodies are detectedidentifying the antibody, or antibodies, in order to select donor cellslacking the corresponding antigen(s) (“antigen-negative blood”)(Hillyer, C. D. et al., Blood Banking and Transfusion Medicine: BasicPrinciples & Practice, Elsevier Science Health Science 2002). Therepertoire of serologic testing methodologies for addressing this taskinclude: direct agglutination, immediate spin test, as well as indirectantiglobulin test (referred to as “TAT”; see I. Dunsford et al.,Techniques in Blood Grouping, 2nd ed. Oliver and Boyd, Edinburgh(1967)). The TAT detects antibodies in the recipient's plasma thatrecognize one of the major antigens (A, B and RhD) expressed on adonor's erythrocytes which thereby can elicit an adverse transfusionreaction.

Reactions may vary in severity ranging from “none” to “severe” (Hillyer,C. D. et al., supra at p. 17). For instance, critical antigens in theABO or Rh blood groups, if mismatched, can induce a severe adversereaction, whereas antigen N, if mismatched, does not. The degree ofseverity also varies depending upon whether the subject is an adult or anewborn child. For example, an offending antigen S may cause only a mildadverse reaction in an adult but can cause severe hemolytic disease ofthe newborn. A primary clinical concern arises from the fact thattransfusion reactions may entail the accelerated destruction ofadministered cells, thereby diminishing the efficacy of the therapeuticintervention. Thus, hematology patients undergoing chemotherapy oftendevelop pancytopenias that, while initially caused by impairedhematopoieisis, often are exacerbated by antibody-mediated destructionof incompatible cells given during treatment; a case in point isthrombocytopenia: as patients become increasingly less responsive andnot infrequently completely unresponsive (“refractory”) to platelettransfusion, they are exposed to an increased risk of bleeding which maybe fatal. To mitigate this risk, these patients receive more frequenttransfusions to maintain at least a minimal platelet count, resulting inexcess consumption of product; these patient also often require extendedcare in hospital, at significant excess expense (Meehan et al 2000,“Platelet Refractoriness: Utilization and Associated Costs in a TertiaryCare Hospital”, American J of Hematology, 64: 251-256 (2000)).

Reducing the risk of allo-immunization, by preventing the exposure ofthe patient to unacceptably immunogenic epitopes, thus remains animportant clinical concern, especially in the context of the emphasis onpatient-centric and preventive medicine codified in the Affordable CareAct, Health and Human services website, athealthcare/rights/law/index.html).

The current practice of confirming the compatibility of units intendedfor transfusion for only the major antigens and, in the event, foradditional antigens if corresponding specific antibodies are detected,is ill suited to advance this objective. In fact, this “re-active”approach often exacerbates the problem when patients require multipletransfusions. This is so because “antigen-negative” units invariablyexpose these patients to new allo-antigens and trigger the proliferationof antibodies whose identification in turn requires increasingly complexlaboratory procedures followed by the search, often under time pressure,for increasingly less common donor units that lack all the cognateantigens for the antibodies now in the mix: a sisyphean task, withundesirable consequences for patients, who are needlessly exposed toincreased clinical risk, and for payers, who bear the excess cost.

The re-active approach, in part, reflects the limitations of theavailable repertoire of serologic methods which are effective only whenantibodies are already manifest. In addition, the extension of routineserologic typing to all clinically relevant antigens is precluded by thelack of appropriate reagents including antisera and the complexity andlimited reliability of labor-intensive protocols requiring specialexpertise and training in immunohematology, particularly whenencountering multiple alloantibodies or weakly expressed antigens.Sensitivity is another concern regarding the accuracy of the results,serotyping is based on the interpretation of agglutination patterns thatreflect the level of antigen expression, and weakly expressed antigensmay be missed.

In contrast, modern methods of DNA analysis such as those described in“BeadChip Molecular Immunohematology” (see Amazon's website under“BeadChip-Molecular-Immunohematology-Profiling-Analysis/dp/144197511X”)are free from these limitations. Thus, the analysis of blood group genesat the DNA level provides a detailed picture of the allelic diversitythat underlies phenotypic variability. As described in a number ofsources (including, Hashmi et al., Transfusion, 45, 680-688 (2005))available methodologies permit the simultaneous analysis of clinicallysignificant single nucleotide polymorphisms within the genes encodingantigens in the Kell, Duffy, Kidd, MNS and other systems including thehighly variable RhD and RhCE genes, Human Leukocyte Antigens, HumanPlatelet Antigens and others. See U.S. Pat. No. 7,612,193 (incorporatedby reference). Furthermore, these methods can eliminate the need forcostly reagents and complex and labor-intensive protocols for serologicanalysis, as well as the need for repeat testing of recipients forantibodies to particular donor antigens, and help in addressing clinicalproblems that cannot be addressed by serologic techniques, such as: thedetermination of antigens for which the available antibodies are onlyweakly reactive; the analysis of recently transfused patients; or theidentification of fetuses at risk for hemolytic disease of the newborn.

The benefit of identifying immunogenic epitopes on the basis ofgenotypes relating to the expression of transfusion antigens is tominimize or eliminate not only the risk of antibody proliferation withits adverse effects, but also the risk of immunizing recipients in thefirst place, and to enable the rapid selection of blood products fortransfusion from a group of donors.

Thus, to reduce the risk of allo-immunization, and the antibody-mediatedaccelerated destruction of administered cells, it will be preferable topro-actively align molecular signatures of recipient and candidatedonor(s) by deploying modern methods of DNA analysis.

While DNA analysis is the de facto standard for identifying stem celland solid organ donors, the prediction of (T-cell receptor) epitopeconfigurations as a function of differences in DNA sequence betweendonor and recipient has remained a challenging and elusive task in thatsetting. Currently, tissue banks seek graft donors whose Human LeukocyteAntigen (“HLA”) alleles must match the recipient's at multiple class Iand class II loci to within not more than two mismatched positions to beacceptable. Thus, donors are assessed on the basis of sequencesimilarity, such that, when a perfect match is not available, graftselection is guided by mere rules of thumb that may deprive certainrecipients of perfectly acceptable (stem cell as well as solid organ)transplants. A rational basis for assessing the impact of mismatchedalleles on epitope configurations and the associated risk of an adversereaction (such as graft rejection or graft-vs-host disease) remains tobe established. (S. Feng, Characteristics associated with Liver GraftFailure: The Concept of a Donor Risk Index,” Am. J. of Transplantation,Vol. 6, pp. 783-790 (2006); K. Lentine, “Cardiovascular Risk AssessmentAmong Potential Kidney Transplant Candidates: Approaches andControversies” Am. J. of Kidney Diseases, Vol. 55, pp. 152-167 (2010).).In contrast, the use of DNA analysis, in the process described herein,forms a critical input to the exclusion of donor units that would exposethe intended recipient to unacceptably immunogenic epitopes. Thus, theprocess described here differs from the genetic cross-matching currentlyused by tissue banks for the selection of stem cells for allogeneictransplants.

A problem in using DNA analysis for establishing molecular signatures ishow to store genetic information in such a way as to permit theselection of suitable products for patients, especially when patients donot receive all treatment at the same institution: this often is thecase with sickle cell patients in crisis, or hematology patientscommencing treatment in the community setting who ultimately requiretertiary care at another institution. The genetic information is morecomplex than is information obtained by serotyping, and the capabilityof interpreting it providing it in clinically actionable form is lesswidely available. An additional problem with genetic analysis is that,as new markers become known, their clinical significance must beassessed so that new markers, if significant, can be added to theanalysis guiding the identification of compatible products for apatient. Accordingly, a system of storing and keeping current suchinformation, and for allowing secure access to it for providingcompatible products to a patient is needed.

Thus, to enable a pro-active approach to the selection of appropriatecells for transfusion, a viable process is needed by which to generate,make available to the patient in “portable” and preferably in “wearable”form, and maintain up-to-date the relevant clinical information providedby these methods while maintaining the confidentiality of the patient'spersonal information.

SUMMARY

Making personal genetic information and molecular attributes into a formwhich is attractive is one way to encourage individuals, potentialfuture patients all, to carry such information with them, so that it isavailable when needed, even if the individual is unconscious orincoherent. Encrypting such information relating to clinicallysignificant attributes and rendering it as a unique molecular signatureallows making it more attractive and ensures that the information willremain confidential (even if observed by someone). By way of a systemcomprising a web-hosted service, the signature can then be provided to aindividual subscribing to the service to be carried as a card or inanother form, or to be displayed by an individual's computer orsmart-phone or PDA. The signature can also be incorporated into jewelry,or tattooed on the skin, or be a computer readable chip, or be in anyother form readily carried by the subscriber.

The system would also include a subscriber identification andauthentication process, so that such health-related information can onlybe released by the subscriber to authorized persons. With such a systemin place, for a subscriber in need of a cellular product (includingblood or blood products), a secure order for such products would beplaced such that suitable products are certified to lack clinicallysignificant markers other than those the subscriber already expresses(as shown by decrypting the subscriber's molecular signature), or forproducts otherwise having a reduced risk of generating an adversereaction.

The epitope profile must be anticipated to evolve as new clinicallysignificant markers are identified, or the relative degree ofsignificance of any known marker changes. Thus, a subscriber's molecularsignature is never complete, and in fact, must be periodically updated,when new clinically significant markers are identified: a new molecularsignature must then be generated and provided to the subscriber. Changesin degree of significance of markers can be dealt with by thewebsite-holding entity matching the product and subscriber, by adjustingweighting, as described below.

In a format of deployment comprising a website accessible by asubscriber, the entire process, including the updating functions, can beperformed as follows: identifying several of the subscriber's clinicallysignificant molecular attributes which are known to be associated withadverse reactions or adverse clinical outcomes as a first uniquesubscriber molecular signature; encrypting this molecular signature andproviding a first encrypted molecular signature to the subscriber. Theunique molecular signature can function as a subscriber-identifying icon(recognized by the website) or optionally, another subscriber identifierfor the website (e.g., a user name ID and password or another code) canbe provided to the subscriber.

As new clinically significant attributes or markers are identified, themolecular signature provided to the subscriber is updated by beingrecalled, destroyed or superseded by a revised molecular signature,where the revised encrypted molecular signature includes encryption ofall the subscriber's clinically significant molecular attributes. Therevised encrypted molecular signature is provided to the subscriber andalso preferably stored at the website. This updating process is repeatedas other additional clinically significant markers are identified.

The molecular signature is used in selecting cellular products suitablefor the subscriber because they reduce or eliminate the risk ofalloimmunization and adverse clinical reactions. Suitable cellularproducts contain no significant antigens/epitopes other than those alsoexpressed on the subscriber's own cells (such products designated ashaving a null allo-epitope profile), or, products which do not have anull allo-epitope profile but are nevertheless considered acceptablebecause the risk of a severe clinical reaction is below a threshold orthe likelihood of an adverse clinical outcome is below a threshold.Optionally, the epitope profile of the product also can be reduced to a(donor) molecular signature.

In operation, after the subscriber is identified and a molecularsignature is provided, the website receives a request for suitableproducts and the subscriber identifier (and preferably also thesubscriber encrypted molecular signature, though that also may be storedalready, at the website or elsewhere). The subscriber is authenticatedby the signature or by the identifier, and then a request for suitableproducts is processed by the website. Once a suitable product is found,the website either allows the subscriber or its designee to directlytransact business with the party holding the product, or stands betweenboth parties and conducts a transaction with each in order to fill theorder (see U.S. Pat. No. 8,504,388, incorporated by reference). Thesubscriber can be charged at any stage in the transaction or at multiplestages. The product request can be by a hospital, physician or othercare provider, or by a supplier of blood products including amanufacturer, or by an intermediary such as a blood broker.

DETAILED DESCRIPTION Definitions

Genotype: a string comprising pairs of (possibly identical) letters fromthe set {A,C,T,G}, over a selected set of variable sites (eg “SNPs”):AT,TT,GC,CA, . . . The invention includes reducing portions of thegenotype to a molecular signature, which is provided to the subscriber.

Allele, Haplotype: a string, or set of strings, comprising letters fromthe set {A,C,T,G} over a selected set of variable sites; a genotyperepresents the superposition of two alleles or haplotypes

Allo-epitope profile: set of known epitopes of interest NOT expressed bythe subscriber.

Alleles and haplotypes (but NOT the genotype) encode epitope(s)associated with antigens of interest: in order to determine asubscriber's allo-epitope profile, alleles or haplotypes must berecovered from the genotype and must be mapped to variable positions inthe amino acid sequence for antigens of interest: for present purposes,epitopes may be identified as a minimal set of one or more variableamino acid positions that uniquely identify an allele at a specificlocus (e.g. HLA-A,-B,-C);

Cellular Products: products containing cells, including blood, bloodproducts, red blood cells, platelets, granulocytes, leukocytes and stemcells, and including markers relating to blood type and tissue type aswell as tissues and organs.

Clinical Allo-Immunization Risk profile: an attribute of an individualwith a specific epitope profile, related to the probability that thisindividual, in the course of receiving N cellular products chosen atrandom from a typical donor population, will be exposed to one or moreof the epitopes s/he lacks (=allo-epitopes) and, given correspondingSCAIR factors, will form antibody against at least one of theseallo-epitopes.

Encrypted Molecular Signature: an encrypted representation of theMolecular Signature from which it is derivable by decryption; agenotype, as defined, may serve as an encrypted Molecular Signature;such an encrypted Molecular Signature preferably is provided in awearable format, as disclosed herein.

Molecular Signature, aka Molecular Attribute Profile: minimally, one of:

-   -   allo-epitope profile of subscriber (this can be released to an        authorized and properly authenticated subscriber representative        such as a care provider); or    -   epitope profile of a cellular product, preferably derived from        the underlying alleles or haplotypes recovered from the        genotype.        the molecular signature comprising an epitope profile may be        augmented by additional molecular attributes relating to the        process of antibody formation, for example the subscriber's HLA        alleles governing peptide presentation to T-cells in the process        of antibody synthesis.

Score for Clinical Allo-Immunization Risk (“SCAIR”); aka SCAIR factor: aproperty of an epitope expressing its immunogenicity, namely, the(conditional) probability that an individual who lacks this epitope,when exposed to it, forms an antibody; this Score may be derived fromclinical immunization records and updated if such probability increases.

In operation, a molecular signature is generated for a systemsubscriber, and provided to the subscriber, in encrypted form so as topreserve the confidentiality of the individual's molecular signatureeven when this is publicly displayed, or, upon authentication, indecrypted form to the subscriber or to someone designated by thesubscriber (e.g., a health care provider, a hospital, or the suppliersof blood products including manufacturers, or intermediaries such asblood brokers). The subscriber's allo-epitope profile, derivable fromthe signature,—incorporates only the clinically significant epitopesknown at the time of generating the signature. However, new clinicallysignificant epitopes may be periodically identified as larger groups ofindividuals are characterized by the more widespread application ofmethods of DNA analysis including new methods of DNA sequencing. Thesystem may require a degree of acquiescence by the relevant communitybefore a new epitope is added to the existing signature, including butnot limited to publication in a peer-reviewed journal, a statisticallysignificant increase in reactions where the epitope is in cellularproducts provided to all-epitope negative subscribers, or acceptance ofthe epitope as significant by clinicians. In order to ensure themolecular signature carried by the subscriber accounts for allsignificant epitopes, new and other, the molecular signature must beperiodically updated.

The encrypted molecular signature can be in a wearable form (as part ofa wristband, necklace, ankle bracelet, or tattoo), can be a card carriedby the subscriber, or can be an electronic display—to be displayed by asubscriber's computer or smart-phone or PDA. It is preferable if it canbe scanned, so that it can be readily authenticated by the website.Additional authentication icons may also be provided to the subscriber.These are also preferably scannable. Such icons may include, but are notlimited to, gravatars, as described in U.S. Pat. No. 7,7476,02(incorporated by reference).

In order to update the molecular signature, the existing signature mustbe recalled or destroyed when the new updated one is issued.Accordingly, carrying the signatures in a readily disposable form, suchas a card or electronic display, is preferred for the subscribers.

Cellular products, preferably, immediately upon being collected at adonor institution, preferably prior to stocking and distributing them,also can be classified by molecular signature, so that, by comparing themolecular signature of a subscriber to that of prospective donor cells,cells unsuitable for that specific recipient are readily identified andexcluded. If the products are obtained from a person who already has anassigned molecular signature, the products would simply be marked withthe same signature. Otherwise, it would be necessary to determine thesignificant epitopes carried by the products, either serologically or byway of genotyping.

The molecular signature is also useful in determining suitability ofcertain drugs for administration. For example, the dosage of warfarincan be optimized by evaluating a set of mutations related to certainenzymes such as cytochrome P450. These mutations or similar ones relatedto other drugs could also be included in a molecular signature.

In operation, generating and providing a subscriber a molecularsignature by way of a website would include the specific steps of(wherein the website could levy a charge for each step or stepcombination):

-   -   generate an identifier for a subscriber;    -   provide a program to generate “MyImmunoMolecularSignature”        performing these steps:        -   generate genotype and render it in a representation that may            include additional encryption, including: random sequence of            position indices; optionally, add “noise”, e.g. shape,            color, orientation, or boundaries; render pattern & combine            with a code, eg QR code (U.S. Pat. No. 5,726,435,            incorporated by reference) or other one or two dimensional            array or bar code; the code may include versioning            information        -   store encryption key on server associated with subscriber            identifier (and/or subscriber molecular signature)        -   notify subscriber: offer choice of medium on which to render            encrypted molecular signature, such as card, display etc.

The steps of providing to the subscriber or its designee the relevantepitope information, on request, would be as follows:

-   -   generate genotype and derive associated molecular signature,        using additional (“private”) information and/or the Clinical        AlloImmunization Risk profile:        -   subscriber or designee logs in, eg, using scanned QR code            associated with signature        -   authenticate subscriber, eg, by matching subscriber            identifier, password        -   validate molecular signature via stored decryption key        -   record request, requester ID (e.g. care provider)        -   reconstruct (“decrypt”) epitope profile, from encrypted            molecular signature uploaded by subscriber; identify risk            profile        -   optionally translate epitope profile into desired format            e.g. Electronic Health Record: HL7, see International            Organization for Standardization website        -   transmit to authenticated subscriber        -   obtain electronic confirmation        -   record transaction

The steps of identifying a suitable product would include most of thesame steps as providing the subscriber epitope information (as above),plus the steps of providing the identity of suitable products to thesubscriber or its designee. Alternatively, the product could beidentified and purchased by the website operator, and then provided tothe subscriber or its designee.

As noted, the subscriber may be administered products which containsignificant epitopes the subscriber does not express, if a determinationis made that the cumulative risk (over multiple transfusions) of anadverse reaction and/or adverse clinical outcome is not significant. Thefirst step in arriving at the determination is therefore to determinethe SCAIR factor—which indicates the risk that the subscriber will formantibodies to the foreign epitopes in the product. Even if the SCAIRfactor is relatively high, that does not end the inquiry, as generationof antibodies alone does not necessarily mean there will be asignificant adverse reaction

Thus, added steps in determining suitable products include:

-   -   analyzing the similarities and differences between the        subscriber's clinically significant genetic markers and the        epitopes they encode, and the clinically significant genetic        markers of candidate products and the epitopes they encode,        namely by deriving and comparing molecular signatures, and        applying weights to said similarities and differences to        generate a clinical risk estimator which estimates the risk of        significant adverse subscriber reactions or adverse clinical        outcomes for each of said available products, where the        weighting is such that the severity of the adverse subscriber        reactions or adverse clinical outcomes is reflected by said risk        estimator function;    -   identifying product(s) for administration for which the clinical        risk estimator is below a cut-off level, and providing such        products or their identities to the subscriber or its designee.

The weights accorded to different epitopes derived from the likelihoodof antibody formation upon exposure, may be adjusted to take intoaccount additional information as it becomes available from sourcesincluding the scientific literature, researchers, clinicians, publishedstudies and other sources. Preferably, weights will be derived fromSCAIR factors of known epitopes; however, once an antibody is formed,the appropriate SCAIR factor is updated to indicate the increasedclinical risk incurred by exposing that subscriber to the cognateantigen (thereby encompassing current practice of selecting“antigen-negative” units): this is important especially for epitope'swith a low original value of the SCAR factor.

The specific methods and processes described herein are representativeof preferred embodiments and are exemplary and not intended aslimitations on the scope of the invention. Other objects, aspects, andembodiments will occur to those skilled in the art upon consideration ofthis specification, and are encompassed within the spirit of theinvention as defined by the scope of the claims. It will be readilyapparent to one skilled in the art that varying substitutions andmodifications may be made to the invention disclosed herein withoutdeparting from the scope and spirit of the invention. The inventionillustratively described herein suitably may be practiced in the absenceof any element or elements, or limitation or limitations, which is notspecifically disclosed herein as essential. Thus, for example, in eachinstance herein, in embodiments or examples of the present invention,any of the terms “comprising”, “including”, containing”, etc. are to beread expansively and without limitation. The methods and processesillustratively described herein suitably may be practiced in differingorders of steps, and that they are not necessarily restricted to theorders of steps indicated herein or in the claims. It is also noted thatas used herein and in the appended claims, the singular forms “a,” “an,”and “the” include plural reference, and the plural include singularforms, unless the context clearly dictates otherwise. Under nocircumstances may the patent be interpreted to be limited to thespecific examples or embodiments or methods specifically disclosedherein. Under no circumstances may the patent be interpreted to belimited by any statement made by any Examiner or any other official oremployee of the Patent and Trademark Office unless such statement isspecifically and without qualification or reservation expressly adoptedin a responsive writing by Applicants.

The invention has been described broadly and generically herein. Each ofthe narrower species and subgeneric groupings falling within the genericdisclosure also form part of the invention. The terms and expressionsthat have been employed are used as terms of description and not oflimitation, and there is no intent in the use of such terms andexpressions to exclude any equivalent of the features shown anddescribed or portions thereof, but it is recognized that variousmodifications are possible within the scope of the invention as claimed.Thus, it will be understood that although the present invention has beenspecifically disclosed by preferred embodiments and optional features,modification and variation of the concepts herein disclosed may beresorted to by those skilled in the art, and that such modifications andvariations are considered to be within the scope of this invention asdefined by the appended claims.

1. A process for improving the identification and administration ofsafer products, including cells and cell-derived products foradministration to subscribers, such that the products identified entaila lower risk of adverse reactions or adverse outcomes when administeredto a subscriber, wherein the process accommodates additional clinicallysignificant attributes, once these are determined to be significant,comprising the following steps: a. storing a unique subscriberidentifier in a device controlled by the subscriber; b. generating andupdating an encrypted molecular signature for the subscriber by: b1.encrypting several of the subscriber's clinically significant molecularattributes which are known to be associated with adverse reactions oradverse clinical outcomes as a first encrypted subscriber molecularsignature; b2. providing sending the first encrypted molecular signatureto the device whereby the first encrypted molecular signature is storedin the device to the subscriber; b3. identifying additional clinicallysignificant molecular attributes that are to be added to the firstmolecular signature; b4. encrypting all the subscriber's clinicallysignificant molecular attributes as a new molecular signature andsending it to the device whereby storing the new molecular signature isstored in the device; b5. repeating steps b1 to b4 as other additionalclinically significant attributes are identified; c. receiving orobtaining the profile of the clinically significant attributes ofcandidate products to be administered to the subscriber; and d.analyzing the similarities and differences between the subscriber'smolecular signature and the profile of the products to be administeredto said subscriber, and administering products which either: do notcontain any clinically significant attributes which the subscriber doesnot also express; or contain some clinically significant attributeswhich the subscriber does not express but said some clinicallysignificant attributes do not render the product unacceptably unsafebased on the anticipated severity of the adverse subscriber reaction oradverse clinical outcome.
 2. The process of claim 1 further including,in the case where the products possess some of the same clinicallysignificant attributes as the new molecular signature, identifying thosewhich are acceptably safe by applying weights to said similarities anddifferences to generate a clinical risk estimator which reflects therisk of adverse recipient reactions or adverse clinical outcomes foreach of said products; and identifying the product(s) for administrationwhich are associated with a weighted clinical risk for the recipientbelow a cut-off level.
 3. The process of claim 1 further includingidentifying products which are acceptably safe based on the risk ofantibody formation upon administration of a product, and identifying, byantigen or epitope profile, the product(s) to be excluded fromadministration which are associated with a risk of antibody formationabove a cut-off level.
 4. The process of claim 2 wherein the likelihoodof destruction of administered cells also is reflected by said clinicalrisk estimator.
 5. The process of claim 2 wherein the likely severity ofthe adverse subscriber reactions or of adverse clinical outcomes also isreflected by said clinical risk estimator.
 6. The process of claim 3wherein determining the risk of antibody formation includes determiningSCAIR factors for the patient's allo-epitopes.
 7. The process of claim 1further including: receiving at the website a request from a patient orthe patient's designee for products suitable for being administered tothe patient, and the patient identifier and encrypted molecularsignature; authenticating the patient identifier; decoding thesignature, to recover the molecular signature including thecorresponding allo-epitope or CAIR profile; and transmitting to theauthenticated requester the attributes of products suitable for beingadministered to the patient.
 8. The process of claim 1 wherein theencrypting further includes the following steps: encrypting arepresentation of the patient's molecular signature as a pattern ofdistinct shapes or colors; and transmitting said pattern to the patient.9. The process of claim 8 wherein the pattern of distinct shapes orcolors is rendered on a card, or is in wearable form for display on thesubscriber's person, or in form for electronic display on a computer orsmart-phone or PDA.
 10. The process of claim 1 wherein all storedsubscriber molecular signatures, patterns and other associatedsubscriber information and medical records are accessible at theweb-site, but only to the subscriber and the subscriber's designee. 11.The process of claim 1 wherein the patient's clinically significantmolecular attributes in a molecular signature associated with likelyantibody formation include epitopes or antigens expressed on circulatingblood cells, such as red blood cells, platelets, granulocytes,leukocytes and stem cells, including molecular attributes relating toblood type and tissue type.
 12. The process of claim 1 wherein there arecharges associated with accessing or using the web-site, as well as foridentifying products suitable for administration.
 13. (canceled)
 14. Theprocess of claim 8 wherein the pattern is worn as jewelry or displayedon a bracelet, or is tattooed on the skin, or is embedded in a computerreadable chip carried by the subscriber.
 15. The process of claim 8wherein the pattern is a one or two dimensional array or bar code. 16.The process of claim 1 wherein the unique subscriber identifier and thesubscriber's clinically significant molecular attributes are stored in adatabase associated with the website.
 17. The process of claim 1 whereinthe molecular attributes include genetic markers.
 18. The process ofclaim 1 further including inactivating the first encrypted subscribermolecular signature.
 19. The process of claim 1 wherein the encryptedmolecular signature is generated by encrypting the subscriber'sclinically significant molecular attributes, or the encrypted molecularsignature is the subscriber's genotype and the device can electronicallytransmit the encrypted molecular signature.
 20. The process of claim 1wherein the unique subscriber identifier is the encrypted molecularsignature.
 21. A process for improving the identification andadministration of safer products, including cells and cell-derivedproducts for administration to subscribers, such that the productsidentified entail a lower risk of adverse reactions or adverse outcomeswhen administered to a subscriber, wherein the process accommodatesadditional clinically significant attributes, once these are determinedto be significant, comprising the following steps: a. storing a uniquesubscriber identifier in a device controlled by the subscriber; b.generating and updating an encrypted molecular signature for thesubscriber by: b1. amplifying using a polymerase chain reaction portionsof a subscriber's genome incorporating the subscriber's clinicallysignificant molecular attributes; b2. encrypting several of thesubscriber's clinically significant molecular attributes which are knownto be associated with adverse reactions or adverse clinical outcomes asa first encrypted subscriber molecular signature; b3. sending the firstencrypted molecular signature to the device whereby the first encryptedmolecular signature is stored in the device; b4. identifying additionalclinically significant molecular attributes that are to be added to thefirst molecular signature; b5. encrypting all the subscriber'sclinically significant molecular attributes as a new molecular signatureand sending it to the device whereby the new molecular signature isstored in the device; and b6. repeating steps b2 to b4 as otheradditional clinically significant attributes are identified; c.receiving or obtaining the profile of the clinically significantattributes of candidate products to be administered to the subscriber;and d. analyzing the similarities and differences between thesubscriber's molecular signature and the profile of the products to beadministered to said subscriber, and administering products whicheither: do not contain any clinically significant attributes which thesubscriber does not also express; or contain some clinically significantattributes which the subscriber does not express but said someclinically significant attributes do not render the product unacceptablyunsafe based on the anticipated severity of the adverse subscriberreaction or adverse clinical outcome.